Exogenous reinfection with tuberculosis on a European island with a moderate incidence of disease.

The frequency and determinants of exogenous reinfection and of endogenous reactivation of tuberculosis in patients previously treated are poorly understood. In Gran Canaria Island, Spain, between 1991 and 1996, 962 tuberculosis cases were confirmed by culture. Drug susceptibility testing was performed on available bacterial isolates and IS6110-based RFLP genotyping was carried out. Twenty-three patients (2.4%) had two positive cultures separated by at least 12 mo, 18 of whom had bacterial DNA available for genotypic analysis. The initial and final isolates from eight (44%) were different genotypes, indicating exogenous reinfection. Six of them were retreated after cure and two retreated after default. Six were HIV seronegative and two were HIV seropositive. Endogenous reactivation was seen in the remaining 10 patients of whom eight were retreated after default and two after cure. Three of the eight (38%) being retreated after default developed multidrug resistance. One genotype was responsible for a second episode of tuberculosis in five cases, three exogenous reinfections and two endogenous reactivations. In the context of a moderate incidence of tuberculosis, exogenous reinfection is an important cause of TB recurrence, even in HIV-seronegative patients.

[1]  V. Jarlier,et al.  [Analysis of restriction fragment length polymorphism (RFLP) of Mycobacterium tuberculosis strains isolated from patients with several episodes of tuberculosis]. , 1996, Pathologie-biologie.

[2]  J T Douglas,et al.  Predominance of a single genotype of Mycobacterium tuberculosis in countries of east Asia , 1995, Journal of clinical microbiology.

[3]  F. Rodríguez de Castro,et al.  The epidemiology of tuberculosis in Gran Canaria, Canary Islands, 1988-92: effectiveness of control measures. , 1995, Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[4]  J. El Baghdadi,et al.  [Molecular typing of Moroccan strains of Mycobacterium tuberculosis]. , 1997, Bulletin de la Societe de pathologie exotique.

[5]  J A Romeyn,et al.  Exogenous reinfection in tuberculosis. , 1970, The American review of respiratory disease.

[6]  S. Opal,et al.  Superinfection with Rifampin-Isoniazid-Streptomycin-Ethambutol (RISE)-resistant Tuberculosis in Three Patients with AIDS: Confirmation by Polymerase Chain Reaction Fingerprinting , 1994, Annals of Internal Medicine.

[7]  J. Bates,et al.  Evidence for infection by two distinct strains of Mycobacterium tuberculosis in pulmonary tuberculosis: report of 9 cases. , 1975, The American review of respiratory disease.

[8]  R. Reves,et al.  The incidence of false-positive cultures for Mycobacterium tuberculosis. , 1997, American journal of respiratory and critical care medicine.

[9]  P E Fine,et al.  The natural history of tuberculosis: the implications of age-dependent risks of disease and the role of reinfection , 1997, Epidemiology and Infection.

[10]  R. Shafer,et al.  Exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis in an immunocompetent patient. , 1995, Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[11]  J. Paul,et al.  Recurrence of HIV-related tuberculosis in an endemic area may be due to relapse or reinfection. , 1994, Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[12]  S. Das,et al.  IS6110 restriction fragment length polymorphism typing of clinical isolates of Mycobacterium tuberculosis from patients with pulmonary tuberculosis in Madras, south India. , 1995, Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[13]  D. Alland,et al.  Exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  R. Shafer,et al.  Exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis in patients with advanced HIV infection. , 1993, The New England journal of medicine.

[15]  G W Comstock,et al.  Epidemiology of tuberculosis. , 1982, The American review of respiratory disease.

[16]  C. Skinner,et al.  Reinfection tuberculosis: two cases in the family of a patient with drug-resistant disease. , 1980, Thorax.

[17]  J. T. Crawford,et al.  Transmission of multidrug-resistant Mycobacterium tuberculosis among persons with human immunodeficiency virus infection in an urban hospital: epidemiologic and restriction fragment length polymorphism analysis. , 1993, The Journal of infectious diseases.

[18]  P D van Helden,et al.  Exogenous reinfection as a cause of recurrent tuberculosis after curative treatment. , 1999, The New England journal of medicine.

[19]  W. Stead,et al.  Phage type of tubercle bacilli isolated from patients with two or more sites of organ involvement. , 2015, The American review of respiratory disease.

[20]  D. Mitchison,et al.  Application of DNA fingerprinting with IS986 to sequential mycobacterial isolates obtained from pulmonary tuberculosis patients in Hong Kong before, during and after short-course chemotherapy. , 1993, Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[21]  T. Sauerbruch,et al.  Mixed-strain infection with a drug-sensitive and multidrug-resistant strain of Mycobacterium tuberculosis , 1995, The Lancet.

[22]  J. Raleigh,et al.  Exogenous reinfection with Mycobacterium tuberculosis confirmed by phage typing. , 1973, The American review of respiratory disease.

[23]  S. Narayanan,et al.  Restriction fragment length polymorphism typing of clinical isolates of Mycobacterium tuberculosis from patients with pulmonary tuberculosis in Madras, India, by use of direct-repeat probe , 1995, Journal of clinical microbiology.

[24]  W W Stead,et al.  Pathogenesis of a first episode of chronic pulmonary tuberculosis in man: recrudescence of residuals of the primary infection or exogenous reinfection? , 2015, The American review of respiratory disease.

[25]  M. C. Román,et al.  Preliminary investigation of Mycobacterium tuberculosis biovars , 1984, Journal of clinical microbiology.

[26]  F. Rodríguez de Castro,et al.  Evaluation of a directly observed six months fully intermittent treatment regimen for tuberculosis in patients suspected of poor compliance. , 1996, Thorax.

[27]  M Juchniewicz,et al.  [Epidemiology of tuberculosis]. , 1970, Pielegniarka i polozna.

[28]  J. T. Crawford,et al.  Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology , 1993, Journal of clinical microbiology.

[29]  E. Nardell,et al.  Exogenous reinfection with tuberculosis in a shelter for the homeless. , 1986, The New England journal of medicine.